WASHINGTON — For at least six months, staffers in the Office of National Drug Control Policy — often political appointees in their 20s — have crossed 17th Street, entered the Eisenhower Executive Office Building, and sat through weekly meetings of an “opioids cabinet” chaired by Kellyanne Conway.

Then they have returned to their desks and reported back to veteran career staff — who have listened, often with disappointment, to the ideas proposed by Conway and Katy Talento, a domestic policy adviser.

The pair insisted at one point that an opioid awareness campaign focus on fentanyl, a concept opposed by those with experience in substance use prevention. Separately, Conway outlined a plan for a marketing partnership with the NFL and MLB, an idea that has not yet materialized.

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Frustrations with the meetings, according to officials familiar with them, are symptomatic of a broader issue: A year and a half into the Trump administration, it remains unclear who, besides Conway, is coordinating U.S. drug policy in the midst of an opioid crisis.

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In theory, it’s the role of the ONDCP to coordinate the effort across the federal government.

Jim Carroll, a former deputy White House chief of staff, has been serving as acting drug czar since Trump announced his intent to nominate him to lead ONDCP in February. But Carroll has little in the way of experience in drug policy or public health, other than time as a Virginia prosecutor handling drug-related cases.

Even before Carroll’s arrival, the ONDCP’s role has been significantly diminished, according to interviews with nine current and former ONDCP staffers, as well as outside drug policy experts, lawmakers, and Capitol Hill staff.

“I don’t understand why Trump and Kelly haven’t gotten some major figure — medical, political, you name it — to run the operation, and then funded it,” said Barry McCaffrey, formerly a four-star Army general who served as drug czar during the Clinton administration, referring to John Kelly, the president’s chief of staff.

Others inside and outside the administration have expressed concern that the agency is being used as a pasture for former Trump campaign workers and administration officials who have left previous jobs. The White House strongly contested that assertion, pointing to recent personnel moves as a sign the administration was sending valued talent to the drug policy office.

Still, at one point last year, three of ONDCP’s roughly nine political positions — which range from entry level to leadership — were filled by 20-somethings, including Taylor Weyeneth, who became the agency’s deputy chief of staff at 24.

After former health secretary Tom Price’s ouster following a scandal over his use of a private jet, two of his key aides wound up with high-level ONDCP jobs: Charmaine Yoest, once the health department’s head of communications, and Kristin Skrzycki, Price’s former chief of staff.

The agency has already cycled through a press secretary (who worked at ONDCP for roughly 10 days before departing), a communications director, and an acting chief of staff; a number of career staff have left.

“ONDCP needs to be re-elevated to serve as the nerve center for the administration’s drug policy,” said Rafael Lemaitre, who worked in public affairs for ONDCP under Bill Clinton, George W. Bush, and Barack Obama. “It should not be a dumping ground for campaign workers who need a job in the Trump administration.”

Hogan Gidley, a deputy White House press secretary, said Trump “selects the highest caliber of individuals from an array of backgrounds and experiences” to fill positions in the administration. He said Conway remains the point person on opioids-related initiatives.

“Kellyanne Conway has done an outstanding job on this issue and continues to convene ‘opioids cabinet’ meetings twice a week with the various federal agencies involved with working to combat the opioid crisis,” Gidley said. “Agency representatives attend these meetings, and report back to their principal.”

Beyond Conway, a sea of other faces have played prominent roles in the administration’s response to the opioid crisis. Chris Christie, the former New Jersey governor, chaired a White House commission on the epidemic. FDA Commissioner Scott Gottlieb has been vocal on opioids issues from treatment to interdiction of international drug shipments. Health secretary Alex Azar — who has made opioids a focus of his agency’s work — tapped his deputy, Brett Giroir, to coordinate the agency’s drug policy efforts and lead a separate interagency task force on pain management.

Giroir’s appointment, according to some current and former administration officials, has largely sidelined the HHS secretary for mental health and substance use, Elinore McCance-Katz, further injecting confusion into who in the administration is tasked with coordinating drug policy. The Department of Health and Human Services did not respond to a request for comment.

It is not the first time the ONDCP has been overshadowed. In 2017, the administration considered cutting its budget by 95 percent, according to a leaked budget document. The White House formally included the same cut in its 2018 budget request, a proposal ignored by Congress.

Even with stable funding, however, the administration has stumbled in its attempts to find a leader for the office.

Trump had considered Frank Guinta, a former New Hampshire congressman, to lead the agency, and Guinta had at one point told associates the White House was likely to announce his nomination within weeks.

The president, however, ultimately nominated Rep. Tom Marino (R-Pa.), a decision seen as a reward for the congressman’s role in delivering Pennsylvania in the 2016 election. Marino withdrew from consideration twice: once citing a family illness and another time after news reports highlighted his role in a bill that weakened the DEA’s enforcement authority.

While Trump eventually nominated Carroll — whose confirmation process has stagnated in the Senate — he has yet to nominate an administrator for the Drug Enforcement Administration.

“I’ve talked to them about an ONDCP director and a DEA administrator,” said John Walters, the drug czar to President George W. Bush. “They’ve had trouble finding a competent person, and part of that is, it’s a gigantic problem and these institutions have failed.”

Sen. Elizabeth Warren (D-Mass.), who sits on the Senate committee overseeing health care, wrote to ONDCP in March seeking information about Carroll’s qualifications for the position.

“While I am pleased that the President has nominated a Director, I am concerned that you have little experience in public health or addiction policy. Since President Trump took office, you have held three different posts in the Trump Administration, none of which have focused on public health,” Warren wrote, later adding: “Your lack of experience is particularly concerning, given the existing lack of drug policy expertise among those tasked by President Trump to combat the epidemic.”

McCaffrey agreed.

“Obviously he’s not a figure that calls Sen. Orrin Hatch and says, ‘I need to see you in an hour.’ He’s not even vaguely the right guy,” McCaffrey said, referring to Carroll. “If you’re going to coordinate drug policy, you’ve got to have someone who’s at the number two or number three level in government. He struck me as barely a placeholder.”

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Others have defended Carroll. Sen. Maggie Hassan (D-N.H.) expressed tepid support after a face-to-face meeting earlier this month, and the Community Anti-Drug Coalitions of America wrote to the Senate committee to express support for Carroll’s confirmation.

ONDCP officials credited Carroll with designating several sites in Alaska as high-intensity trafficking areas, expanding the federal enforcement program to all 50 states.

Carroll’s appointment, to many, also represents a new front in a long-running battle between ONDCP and the Office of Management and Budget, which has long resented that ONDCP has some budget authority over federal agencies that work in drug policy.

Before becoming a deputy White House chief of staff, Carroll worked for several months as OMB’s general counsel. While some within ONDCP initially feared Carroll would align himself with the West Wing’s stance on the grant programs, he appears to have sided with his new agency.

Meanwhile, lawmakers have complained in public that ONDCP is understaffed, was late in delivering a draft of its reauthorization bill to Capitol Hill, and, most importantly, has yet to release a national drug strategy.

While the final document, issued annually, is perhaps ONDCP’s biggest responsibility, the office has not published an updated national drug strategy since the final year of the Obama administration. At one point, sources said, the agency had a document largely prepared for a release early this spring.

Carroll’s appointment, however, is said to have short-circuited that process. The agency is now targeting a summer release.

An earlier version of this story incorrectly stated that Sen. Elizabeth Warren is a member of the Senate Judiciary Committee.

As we get older our bodies simply wear out. We all do it. Much like a car does. In these instances we need specialists in AC, wheel alignment, electrical and of course body work.
Grandchildren do not need to see the medications our parents and grandparents take (if they are still living). It is called better living thru chemistry.
The GP is necessary for referral for insurance purposes and serves as a “gatekeeper” to our health.
I almost forgot the psychiatrist. You will need one of these as well as our anxiety increases and perhaps the coatings our nerves wears thin.
I am not comfortable with a freelance (novice) writing articles about advanced health and various physicians we need.
Life is an education. We (you) do not fully appreciate an illness or death until you have experienced it first hand for your health.

This may help you to understand where I’m coming from. I have no problem with people with chronic pain trying to get relief. I do have a problem with looking to only drugs to get relief from pain, or a cold. I’m from the generation who knew their family doctor so well they even made house calls, on occasion. I take two of my friends who are both on Medicare to their doctors’ appointments, & have been for the past two years. What I see happening is they go to these specialists, including pain doctors, & are prescribed drugs for whatever issue they are experiencing…back pain, stomach problems, depression, dizziness. The specialists are not trained in wholistic medicine & solely prescribe drugs. That ends up causing more side effects. The doctor followip appointments NEVER end…and neither do the ailments. It’s a “puppy mill” of drug prescriptions! Here is that article:http://www.dailypress.com/news/military/dp-nws-hampton-va-opioids-20180119-story,amp.html

We are, in general, relying on prescription drugs, way too often. When kids see their parents & grandparents using profusely, they get the message that drugs are okay.

Nancy no it doesn’t explain your stand!
My medical information is not your business!
But to try and open your narrow view I have several drs and my counselor who at very involved with my chronic pain management!
I do physical therapy, see my therapist, have done alternative treatments to include acupressure acupuncture and reiki, daily three times a day stretching. We have tried other non narcotic meds that caused worse side effects than my pain meds.
So you have no idea what all of the law abiding CPP do with their full circle care! This is just a few things I do as part of my care in addition to my pain meds. Nuff said and no more time is going to be given to you ! We aren’t the enemy!

Whatever political appointee is in charge, you can begin by re-educating physicians as to our/your expectations. Like the NRA is to guns, big PHARMA is to doctors.
I recently had miniscus surgery. I rarely take any medications with the exception of over the counter allergy meds. My doctor prescribed 30 Percocet for my post op discomfort…Actually I never had any discomfort! I didn’t even need Ibprophen. I still have the 30 Percocet pills in my bathroom drawer. A society that reveres drugs as the solutions to all pain, discomfort & ailments, will continue to produce addicts & drug abusers, just like a society that reveres guns will produce school shooters. Change the message & we may get better outcomes.

I think it’s wonderful that you didn’t need your pain meds after surgery and applaud you for leaving them alone. However, there are millions of people that have been living with chronic pain for more than 10 years and I happen to be one of them. Pain is a thief. It steals your life as you once knew it. Unless you have experienced that kind of pain and what that chronic long term pain takes from you then you shouldn’t be a part of the solution to the opioid problem. Those of us that can’t function physically without it don’t have a problem taking
drug tests, monitoring, or any other type of controlled treatment. We do want opioids to stop getting into the wrong hands. We want doctors to stop prescribing to people that don’t really need it. But cutting doses back for those of us that suffer is not necessary. We are not the problem. We deserve compassion while new regulations are developed to protect the people that are using the drugs for recreational purposes and from those that are selling their drugs rather than taking them . There are simple steps that can be taken to cut 80 % of these abuses. It’s not that complicated. So I’m saying that the illegal use and sell of opioids can be curbed while ensuring compassion for those of us that need them in order to have some sort of a meaningful life. It’s inhumane to cut back dosing amounts to people that seriously need a certain level of pain relief. It does nothing to stop the abuse by those people who don’t need them at all.

I agree with all of us who have lived with chronic pain people need to experience it to understand it. So slap yourself on the back for not taking pain meds. BTW 30 pills are standard for surgeries with no refills. So happy for you! You have no idea what this which hunt is doing to pain patients across the contry! These meds taken properly proved a quality of life you’ll never understand ! They don’t know what the are doing band are harming many and threatening the vary physicians that care legally with federal prosecution ! Sleep on that

Chronic pain must be experiences to be understood. That is why Geriatric make the best physicians. The curtain between what happened between PROP and CDC concerning the Guidelines has been pulled back similar to the curtain that the Wizard hid behind in the Wizard of OZ. The FDA never approved those guidelines. The correct statistics can be found here. http://www.atipusa.org I urge each and everyone of you to take a look and walk thru and orthopedic and oncology floor. Look at the patients, Work a week doing hospice rounds. It appointed unto every person to die..add to that a part of life filled with pain and agony. Never forget.